Evaluating the indoor and outdoor environment: using a simple method

Housing is the conjunction of the dwelling, the home, the immediate environment and the community. Between 1960 and 1980, the urban population in developing countries more than doubled and is expected to reach 56% of the total population by the year 2025. In many cities, the development of squatter settlements and shanty towns had grown rapidly causing the destruction of green areas. The number of people living in urban slums and shanty towns is an indicator of conditions in the cities and the United Nations had estimated that about one-third of urban dwellers in developing countries live in such settlements. Poverty is highly prevalent among the residents of these areas. Outdoor environmental degradation, together with the social degradation affects the health of the urban population especially the poor causing a burden of ill-health, disability, poor indoor housing, and high maternal and infant mortality. The aim of the present study is to evaluate the indoor and outdoor environment using a simple method and to assess its reliability and validity. The scoring system, which was developed for the assessment of the indoor and outdoor environmental levels included 36 items [18 for the indoor and 18 for the outdoor] using a questionnaire. Results revealed that the proposed scoring system was able to reveal significance difference between served [water, electricity, and sewerage system were available] and unserved areas when using t-test, z-test, and chi-square testing. The proposed scoring system was reliable and valid especially in indoor assessment. Outdoor scores might need more modifications to improve its reliability

Maternal serum alpha fetoprotein among pregnant females in Alexandria

Maternal serum alpha fetoprotein [MSAFP] was introduced as a screening test for congenital malformations especially neural tube defects [NTDs] two decades ago. However, many factors were known to affect its level. From these are racial differences and maternal weight. The aim of the present work is to illustrate the normal distribution of MSAFP among working pregnant women in Alexandria in gestational age 16- 18 weeks, to identify some of its determinants, and to determine the specificity and sensitivity of MSAFP for the detection of congenital anomalies and adverse pregnancy outcome. A sample of 608 pregnant working women who were 16-18 week gestation was recruited for the study from the antenatal clinic affiliated to Gamal Abdel Nasser Health Insurance Hospital in Alexandria. The enrolled women were interviewed using a structured questionnaire and a blood sample was collected from each of them to measure the level of MSAFP. At the expected time of delivery, Gamal Abd el Nasser Health Insurance Hospital was visited to collect data about the outcome of pregnancy of the enrolled women. The median of MSAFP level for deliveries with no congenital anomalies were 25.5, 33.5, and 53.2 IU/ml, at gestational weeks 16, 17 and 18 respectively. The significant variables related positively to MSAFP level included abortion or stillbirth, congenital anomalies in the index pregnancy, gestational age, bleeding during pregnancy, gestational diabetes, twin pregnancy, consanguinity between maternal parents, history of congenital or genetic diseases in maternal family, and caesarian section deliveries. Fatigue score was negatively correlated to MSAFP level. Using MSAFP multiples of median [MOM], 42.9% of abortions and stillbirths, 57.1% of twin pregnancies, 31. 25% of preterm deliveries and 27.3% of low birth weight had levels of 3 MOM or more. One fourth of the congenital anomalies were below 0.5 MOM and 41.7% were at or above 3 MOM. The sensitivity of MSAFP test for the detection of NTDs [cutoff point 2.5+ MOM] or Down syndrome [cutoff point <0.5 MOM] among the study sample was 100% [Cl: 19.8-100%]. Specificity for NTDs was 92.7% [Cl: 90.3-94.6%], while the specificity for Down syndrome was 89.1% [86.3-91.4%]. The sensitivity for adverse pregnancy outcome [cutoff point <0.5 or 2.5+ MOM] was 41.6, and the specificity was 85.8%.In conclusion, the cutoff points of MSAFP of the study sample are different from those for other populations. Different factors affect the level of MSAFP including adverse pregnancy outcomes. It is recommended to introduce antenatal screening for congenital anomalies as a routine screening test during pregnancy using levels adapted from the local population for cutoff point determination

Malnutrition among children 6-24 months attending MCH centres in Alexandria an epidemiologic study Part I: Prevalence

A cross-sectional nutritional survey of children aged 6-24 months [weaning period] attending MCH centres in Alexandria governorate through the year 1988-1989 was conducted with the aim of determining the prevalence of protein calory malnutrition. The sample size was 1000 children chosen from 6 MCH centres in Alexandria [one centre for each zone]. The sample was distributed along the six centres in proportion to the total number of infants recorded to have attended those centres through 1985. The centres were visited during the period starting November 1988 through June 1989. Each centre continued to be visited until the number decided to be included was completed. The study included the determination of age and the measurement of height and weight-Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age, and weight for length in terms of a cut off point of 2 SD below the median of that of reference [Waterlow system]. Gomez classification using weight/age as a parameter was used to diagnose undernutrition. The results of the study revealed a prevalence rate of undernutrition of 25.6% which was mostly of the first degree as expressed by Gomez categories. When expressed using waterlow system a prevalence of stunting of 29.7% was observed while wasting was observed in only 0.7% and concurrent wasting and stunting constituted 0.1%. These results were considered to be relatively lower in comparison to earlier similar studies. It was thus recommended that similar surveys for preschool age children in Alexandria and other regions of Egypt would be valuable

Infant, neonatal and postneonatal mortalities in Egypt and Alexandria Governorate: trends and prediction

This study aimed at determining the trend of infant mortality, neonatal mortality, postneonatal mortality and the ratio of postnenonatal mortality to neonatal mortality% during the last 27 years for Egypt as a whole and Alexandria Governorate with investigation of the trend change after eliminating the effect of National Control of Diarrheal Diseases Project and Predicting the expected situation of infant mortality profile for future years. The rates of Egypt were obtained form CAPMAS while rates of Alexandria Governorate were calculated using the original data. Time Series Analysis using the method of least squares for determining the slope of the best fitting straight line was carried out to calculate the trend and predicted the expected rate values. An evident on-going declining trend in infant mortality rate, postneonatal mortality rate and ratio of postneonatal mortality to neonatal mortality% was experienced in Egypt and Alexandria and it was faster in Alexandria. On eliminating the effect of the rehydration program a delayed lowest expected rates wee detected. The neonatal mortality ate decline showed the same slope even after elimination of the program effect. Prediction of future rates showed better chance of child survival of Egyptian infants and it would be observed faster in Alexandria

Comparative study between recorded and actual causes of maternal mortality in Alexandria governorate during 1985

This study was conducted to compare between recorded and actual causes of reporductive deaths among women in Alexandria governorate in the age group 15-49 years during the year 1985 and determine the extent to which it is maternal. Record review of six health offices in Alexandria governorate [chosen randomly so that each medical zone was represented by one health office] was done. Data about 158 deceased females were obtained. Home visits to 148 families of deceased females were performed to obtain information about the actual cause of death and the health condition of the deceased females before death. Results showed discripency between health offices records and home visits data regarding causes of death in the reproductive age and specifically causes of maternal mortality that was also under-reported

Effect of child loss on fertility behaviour 1 Replacement and biological effects of child mortality

This study was carried out with the aim of investigating the effect of replacement and biological effects of child mortality on fertility behavior in an urban and a rural setting in Alexandria governorate. The data were collected through a questionnaire interview. The study revealed the following results: - Child mortality leads to high fertility behavior in both areas as evidenced by positive replacement and biological effects

Effect of child loss on fertility behaviour: II effects of insurance motivation and societal response mechanisms on attitudes and practices towards family planning

The study was carried out with the aim of investigating the effect of insurance and societal effects of child mortality on the attitudes and practices towards family planning in an urban and a rural settlings in Alexandria governorate. The data were collected through a questionnaire interview. The sample was a purposive sample of 600 women, half of it from an urban area and the other half from a rural area. Each sample was classified into women who had experienced child loss of at least one among the first 3 live births [at least 100 women] and women without child loss as a control group [to complete the sample to 300]. The study revealed that child mortality leads to high fertility attitudes and practices in both areas as evidenced by positive insurance and societal effects